Posted in Access to healthcare, advance-pricing, Economic Issues, Health Insurance, Healthcare financing, Independent Physicians, Medical Costs, Medical Practice Models, out-of-pocket costs, Patient Choice, Price Tansparency, primary care, Uncategorized

Wealth Extracting “Insurance” Bureaucracy vs Real Value-based Care: #DPC

From Dr. Lee Gross, Epiphany Health:

“New patient in the office today had a CT scan ordered by his urologist for presumed symptomatic kidney stones, which was denied by his insurance for 2 months. I ordered the study stat, cash pay. Done 30 minutes later, $220 cost paid by the patient. Stone identified, results given same day. Treatment and care plan initiated. Now that we have a diagnosis, the urologist has the insurance logjam relieved to proceed with a care plan if our conservative therapy is ineffective. Insurance is frequently an obstacle to health care.” #DPC

https://www.facebook.com/groups/DPCdocs/permalink/3473547759342175/

Posted in Access to healthcare, advance-pricing, Economic Issues, Health Insurance, Healthcare financing, Medicaid, Medical Costs, medical inflation, Medical Practice Models, Medicare, out-of-pocket costs, Patient Choice, Price Tansparency, Quality, Uncategorized

G. Keith Smith, M.D. — Health “Coverage” as a Distraction


I think it is good to be alert to any discussions that are “downstream of a flawed premise.” Let me explain.

When I hear, for instance, that the “flat tax” is preferable to the current income tax, I think to myself that this is a discussion of the knife versus the axe, a conversation far downstream of one addressing government spending or the very legitimacy of denying someone their earnings. After all, victims don’t generally care what the mugger does with their money. They just resent being mugged and no discussion about whether the mugger used a knife or a gun will likely provide any solace.

Similarly, I would argue that arguing for everyone to have health “coverage” is far downstream of the more original problem: the cost of healthcare. To provide “coverage” for everyone in the current climate of gross overcharging primarily serves the interests of those who employ the “what can I get away with” method of medical pricing.

The fierce push back against true price transparency by the cronies in the medical industry makes more sense in this context, as price honesty denies them access to everyone’s blank checkbook as the health cronies are well aware.

Supporters of government-guaranteed “coverage” object with the following arguments.

First, coverage is equated with healthcare. While millions of Canadians streaming across the border to secure their health needs could be used to refute the idea that coverage is synonymous with care, this disconnect has become more apparent in this country. Each passing day reveals Medicaid and Medicare “coverage” to be a “black mark,” an actual obstacle to obtaining care, as these government programs and their associated rationing through price controls and hassles are creating the lines the central planners intended. Physicians are either dropping out of these programs altogether or they are limiting their exposure to patients with this “coverage.”

Another objection points to the relief from financial devastation that having “coverage” represents. Keep in mind that not only are well over half of the bankruptcies in this country medically related, but almost three quarters of those filing for medical bankruptcy have insurance. This points powerfully to cost as the root cause of medical economic ills.

Acknowledging this is a slippery slope for the objector, however, for no economic system better provides for resource allocation than the market and the cronies and their government pals know this as well as anyone.

The market is the only source of price deflation with simultaneous improvement in quality. This powerful competitive mechanism has brought affordability to countless products and services in all industries and has begun to bring rationality to health care pricing as more physicians and facilities honestly post their prices for all to see.

Rather than focus on “coverage,” which allows the cronies to continue their financial feeding frenzy, we should remain unalterably focused on cost. The competition unleashed will result in a medical price deflation the likes of which will cause even the most skeptical objector to re-evaluate the role of “coverage” in the provision of payment for health care.

This is no prediction. This is exactly what is happening here in Oklahoma where so many health professionals have embraced the same market discipline every other industry must endure. The reasonable prices and high quality of care, have had such a wide appeal that Oklahoma City has evolved into a medical tourist destination for many patients far from here, while simultaneously bringing savings in the millions of dollars to those who actually pay for healthcare, locally.

This is my answer to another objection from those who claim the inapplicability of market competition to health care.  Whether the focus on “coverage” is a deliberate distraction by the crony propaganda machine or a well-meaning but misguided attempt to provide better access to care, we must keep our eyes on the “price transparency ball.” The Oklahoma market is already harshly judging those attempting to avoid this gaze and I believe this trend will continue as long as we identify, challenge and reject conclusions downstream of their flawed premises.

Posted in Access to healthcare, advance-pricing, Direct-Pay Medicine, Direct-Pay Practice Models, Entrepreneurs, Healthcare financing, Independent Physicians, Medical Costs, Medical Practice Models, out-of-pocket costs, Patient Choice, Patient Safety, Patient-centered Care, Policy Issues, Price Tansparency, Quality, Uncategorized

Transparent Pricing for Medical Emergencies | The Emergency Center

What the status quo apologists and the naysayers said was impossible, is a reality:

Emergency services with transparent pricing and NO surprise bills!

“Always staffed with board-certified physicians, ICU- and ER-trained nurses, X-ray technologists and helpful administrative personnel, The Emergency Center offers the same comprehensive emergency care and treatment as a hospital ER, without the wait. State-of-the-art CT, ultrasound, x-ray, and lab services on-site combined with compassionate care provides an unparalleled patient experience.

The Emergency Center and OnDEC Health have partnered together to offer direct contracts for emergency room visits, urgent and primary care, plus telemedicine. OnDEC Health’s innovative direct contracting opportunities save employers significant dollars on ER claims, while offering their members 24/7, no-wait access to premier concierge style freestanding ERs and more.”

Peyton Vooletich

Director of Business Development

https://www.theemergencycenter.com/fort-worth-er/

Posted in Access to healthcare, advance-pricing, Direct-Pay Medicine, Direct-Pay Practice Models, Entrepreneurs, Healthcare financing, Independent Physicians, Medical Costs, Medical Practice Models, out-of-pocket costs, Patient Choice, Patient Safety, Patient-centered Care, Policy Issues, Price Tansparency, Quality, Uncategorized

Transparent Pricing for Medical Emergencies | The Emergency Center

What the status quo apologists and the naysayers said was impossible, is a reality:

Emergency services with transparent pricing and NO surprise bills!

“Always staffed with board-certified physicians, ICU- and ER-trained nurses, X-ray technologists and helpful administrative personnel, The Emergency Center offers the same comprehensive emergency care and treatment as a hospital ER, without the wait. State-of-the-art CT, ultrasound, x-ray, and lab services on-site combined with compassionate care provides an unparalleled patient experience.

The Emergency Center and OnDEC Health have partnered together to offer direct contracts for emergency room visits, urgent and primary care, plus telemedicine. OnDEC Health’s innovative direct contracting opportunities save employers significant dollars on ER claims, while offering their members 24/7, no-wait access to premier concierge style freestanding ERs and more.”

Peyton Vooletich

Director of Business Development

https://www.theemergencycenter.com/fort-worth-er/

Posted in Access to healthcare, Direct-Pay Medicine, Direct-Pay Practice Models, Economic Issues, Health Insurance, Healthcare financing, Independent Physicians, Medical Costs, Patient Choice, Price Tansparency, Self-Insured Companies, Uncategorized

Jay Kempton: An Unorthodox Benefits Solution – Healthcare Americana

Healthcare Americana, Chris is joined by Jay Kempton of The Kempton Group and co-founder of the Free Market Medical Association (FMMA).

Chris and Jay discuss novel ways of implementing employee benefits, why there are barriers to change, and the upcoming FMMA conference.

https://healthcareamericana.com/episode/jay-kempton-an-unorthodox-benefits-solution/

Posted in Access to healthcare, advance-pricing, Affordable Care Act (ObamaCare), CPT billing, Deductibles, Dependency, Direct-Pay Medicine, Direct-Pay Practice Models, Economic Issues, Employee Benefits, Health Insurance, Healthcare financing, Individual Market, Medical Costs, medical inflation, Medical Practice Models, Organizational structure, outcomes measurement, Patient Choice, Policy Issues, Price Tansparency, Self-Insured Companies, Self-Insured Plans, The Triple Aim, Uncategorized

U.S. Healthcare: A Case Study of What Happens When “Insurance” Supplants Price-Transparent Markets

By Robert Nelson, MD

Our health insurance-based third-party payer protocols have pernicious and nefarious economic consequences on the cost of medical care; and in many ways has diminished access due to regulatory complexities that accompany these interventions.

The undeniable result continues to be a rampant increase in healthcare prices, which is catalyzed by the economic distortions of the 3rd party payer effect and perpetuated by the price-obscuring distortions of the CPT billing cycle.

We have taken the concept of insurance, designed to pay out rare higher-priced claims on unpredictable events, and turned it into a product whose design promotes an incentive for everyone to use it as often as possible.

Insurance is sustainable only when the financial risks of individually rare events are spread over a large population. When it also becomes a funding source for anticipated and affordable events, combined with a perverse incentive to utilize it to the margin, the result is the creation of a perpetual payout fund.

The costs of sustaining this model are never satisfied, being squeezed by patients who are chasing the benefits and providers who chase the billing codes to achieve maximal reimbursement.

As evidence for the negative consequence of misusing insurance as a pass-through system for virtually every healthcare expense (accelerated by passage of the ACA), we can examine the employer-sponsored group market premiums.

From 2007 – 2017 the average premium for family coverage increased by 55% and employee contribution rate as a share of premium cost increased by 74% over the same 10-year period; while median household income went up by only 3%.

To add financial injury to insult, the percentage of employees with an out-of-pocket maximum of greater than $3,000 doubled, going from 30% to 60% of employees.

“Eighty-one percent of covered workers have a general annual deductible for single coverage that must be met before most services are paid for by the plan. Among covered workers with a general annual deductible, the average deductible amount for single coverage is $1,505.” ~KFF.org

Between 2012 – 2017, the percentage of covered workers with a general annual deductible of $1,000 or more for single coverage has grown substantially, increasing from 34% in 2012 to 51% in 2017. Thirty-seven percent of covered workers in small firms are in a plan with a deductible of at least $2,000, compared to 15% for covered workers in large firms.

In the ACA individual market insurance exchanges, single coverage premiums (unsubsidized) increased by 62% and family coverage premiums increased by 75% just since implementation of ObamaCare!

Our third-party payer system has created a dependency paradox!

The same funding method that contributes to runaway costs also causes us to be more dependent on it for access. This guarantees that Healthcare will cost significantly more than the sum of its individual parts, and will continue to escalate faster than our ability to pay for it.

The costs associated with health plan premiums (aka insurance) have become a surrogate for health-care costs.

Now let that sink in!

In what other market does the cost of an insurance product act as substitute for the aggregate cost of the product or services that it insures?

Now apply a similar scenario to the auto insurance market. It doesn’t take much imagination to extrapolate how that would play out. But if you want some help visualizing the scenario, here’s a brief vignette. https://lnkd.in/eUGeCKv

Self-insured employer health plans are in a unique position to break out of this dependency paradox.

By contracting with a Direct Primary Care practice and re-routing subsequent encounters away from the more expensive insurance-based protocols, Self-insured employers can utilize creative plan designs to cut costs and improve employee satisfaction.

Data from the Qliance experience, and supported by other self-insured employer’s experiences, utilization of efficient primary care via the DPC model reduces unnecessary downstream care by approximately 50%, with the resultant aggregate cost savings of nearly 20%.

The caveat being, as we double the number of primary care visits combined with longer visits to adequately address problems, the need for emergent visits, ER visits and specialty intervention drop significantly.

A similar level of savings for direct-pay lab tests was noted in data published in 2014 by CMT journal comparing lab fees charged to a Direct Pay practice by the lab vs. the CPT billed charges by the lab (assuming patient had no coverage or had not met their deductible). For five common blood tests the savings was 89% by not using insurance, with lab billed charges of approximately $782 compared to a direct pay cost of $80. Plum Health, a direct primary care practice in Detroit, shows similarly impressive lab test savings of 87% on six common blood tests; $811 vs $106.

Many Self-insured companies are beginning to discover the value and savings in this approach, while breaking free of the coverage trap and the myth that health insurance equates to health care; and the realization that so-called “access” to inflated pricing and the phony discounts used to fleece the buyer is no longer a conversation they are willing to have.

Posted in Access to healthcare, Accountable Care Organizations, Affordable Care Act (ObamaCare), CPT billing, Economic Issues, Health Insurance, Healthcare financing, Independent Physicians, Influence peddling, Medical Costs, Medicare, Patient Choice, Patient Safety, Policy Issues, Price Tansparency, Uncategorized

Wax: Making a Killing in American Health Care, a Step-by-Step Guide

Master this how-to guide and you’ll be on your way.

https://www.breitbart.com/politics/2019/12/03/craig-m-wax-do-making-a-killing-in-american-healthcare-a-step-by-step-guide/

Posted in Access to healthcare, Crony Capitalism, Economic Issues, Government Regulations, Healthcare financing, Independent Physicians, Medical Costs, Patient Choice, Policy Issues, Price Tansparency, Uncategorized

Institute for Justice: “North Carolina Surgeon Wins First Round in Fight to Eliminate State-enforced Medical Monopoly”

 

justin-wilson-IJ2_6803-150x150
by Justin Wilson

 

“The court correctly rejected the government’s argument that Dr. Singh needed to apply for a CON before bringing this case,” said IJ Attorney Renée Flaherty, who argued the motion. “No one should have to go through an unconstitutional process in order to challenge it. We look forward to showing that North Carolina’s CON law unconstitutionally favors existing businesses at the expense of Dr. Singh and other medical providers.”

In July 2018, IJ and Dr. Singh, a Winston-Salem surgeon, and his business, Forsyth Imaging Center, sued the Department of Health and Human Services, alleging that North Carolina’s CON law is unconstitutional because it bans medical providers from offering services patients need solely to protect existing providers from competition. In order to receive a CON, providers must persuade state officials that new services are “needed” through a cumbersome process that resembles full-blown litigation and allows existing businesses, like established hospitals, to oppose their applications. Even after a CON is granted, existing providers can appeal the decision. Dr. Singh should not have to go through such a burdensome process just to provide affordable services that patients need.

North Carolina Surgeon Wins First Round in Fight to Eliminate State-enforced Medical Monopoly